Doctors Provide Innovative Ideas on Sleep Apnea

Omaha doctors share ways to solve sleep apnea

By the time people see Dr. Ann Edmunds about their sleep apnea, the sleep disorder has usually been bothering them for weeks, if not months. The person with sleep apnea and their partner are likely sleeping in different rooms, and the partner without sleep apnea has become seriously worried about the other person’s health. It is the partner’s concern that often brings the couple to Edmunds’ office at the Omaha Ear, Nose and Throat Clinic, near 168th and Pacific Streets.  It is there that the partner tells Edmunds that what worries them most is the occasional stops in breathing.  “Some people notice this and it makes them nervous,” Edmunds said.

Sleep apnea is a disorder that should make people nervous and be taken seriously. It frequently disrupts sleep and contributes to daytime sleepiness. More than 18 million Americans suffer from the sleep disorder, according to the National Sleep Foundation, a nonprofit research and advocacy group. “When sleep apnea is left untreated and undiagnosed, patients are more likely to develop cardiovascular disease and a metabolic syndrome like diabetes,” said Dr. Robin Khan, a sleep apnea dentist at the Dentistry For Health near 105th and Pacific Streets. “Premature aging is a problem as well.”

“Daytime sleepiness caused by sleep apnea can also increase a person’s risk of being in car accidents, lower their quality of life, and reduce their sex drive,” explained Dr. Naresh Dewan, director of the sleep medicine program at Creighton University.

“You might have sleep apnea if you have a history of snoring, frequently stop breathing while trying to sleep, or gasp for breath during the night,” Dewan stated. You also might have sleep apnea if you still feel tired despite getting seven to eight hours of sleep. “Your spouse or a bed partner may sometimes be the best judge to observe the snoring and breathing pauses at night,” he said.

“Sleep apnea patients also frequently toss and turn in bed,” said Dr. George Thommi of Midwest Pulmonary Critical Care, which has an office near 86th and Cass Streets. “The patients can fall asleep in bed right away but they often don’t achieve good rest,” he explained.

“Certain physical traits also make people more likely to experience sleep apnea, including being overweight,” Khan said. Men with a neck circumference larger than 17 inches also are more likely to have sleep apnea, as are women with a neck circumference greater than 15 inches. “If a patient has any of the above symptoms or has a history of cardiovascular disease, they should speak with their physician about being screened,” Khan stated.

Children also can suffer from sleep apnea. Edmunds explained that children who have sleep apnea will often act up in school and get misdiagnosed with attention deficit hyperactivity disorder. But the children often act up because they’re trying to stay awake. Once mom or dad picks them up after school, the tired children immediately fall asleep in the car. The good news for adults and children, sleep apnea can easily be tested and treated.

“Children usually suffer from sleep apnea because of large tonsils and/or adenoids, the lymphatic tissue right behind the nose,” Edmunds said. Once the tonsils and/or adenoids are removed by surgery, most children no longer have sleep apnea. That was the case for 11-year-old Olivia Weiss, a sixth grader at Elkhorn Ridge Middle School. Earlier this year, Olivia was snoring through the night and often tossing and turning, according to her mother, Julianne Weiss. Edmunds, who knew Olivia had large tonsils from previously treating her for strep throat, suggested the family get Olivia tested for sleep apnea, which they did. In June, Olivia’s tonsils were removed. These days, Olivia sleeps quietly through most of the night. “Her bed doesn’t look like a tornado when she wakes up in the morning,” her mother said. “She’s getting a more restful sleep.”

For adults, the diagnostic and screening process is simple. “Patients can pick up a monitoring device, about the size of an iPhone, and wear it to bed at night for an initial screening option,” Khan said. “Screening is easy.”

The patient’s bed partner coming with the prospective patient to the initial visit can be “extremely valuable and important,” Dewan said. He can diagnose sleep apnea with help from an in-lab sleep study or an at-home sleep study. People typically have one of the two main types of sleep apnea; obstructive sleep apnea, which occurs when throat muscles relax and block a person’s airway, or central sleep apnea, which happens when the brain doesn’t send proper signals to the muscles that control breathing, according to the Mayo Clinic.

“Breathing pauses for 10 seconds or longer can be read as an apnea,” Dewan said. “If a patient undergoes an in-home sleep study and the results come back negative, it’s important the person does not stop there,” he continued. “Most patients with a negative home sleep study require further evaluation with an in-lab sleep study.”

Treatments can vary for people who have sleep apnea. A mandibular advancement device, which is worn in the mouth, often works well for people with mild to moderate apnea, according to Khan. For people with severe sleep apnea, continuous positive airway pressure (CPAP) often helps. CPAP, like other treatment tools, including the mandibular advancement device, helps open a person’s airway, Khan mentioned. “I like to tell patient that I am going to create a larger garage to park their car. The tongue being the car and the mouth is the garage,” she said. “Surgical options exist as well,” she added.

The Omaha doctors also recommend behavioral changes for some patients. “Quitting smoking might reduce the severity of a person’s sleep apnea,” Dewan said. He also encourages all sleep apnea patients who are obese to lose weight. “Weight loss of even 10 to 20 pounds can reduce the severity of sleep apnea by 20 to 30 percent or more. Significant weight loss, 50 pounds or more, can eliminate sleep apnea and the need for CPAP,” he explained. Khan said losing 10 to 20 pounds is the “best form of treatment.” Avoiding sleeping on your back also can help reduce sleep apnea.

Dewan also offered these suggestions, which could lead to better health for everyone, including people without sleep apnea: Control your food portion sizes for calories, exercise regularly – 45 minutes a day, five times a week, and get sufficient sleep – seven to eight hours a night.

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